CLINICAL RESEARCH

Dental implants with fixed prosthodontics in oligodontia:

A retrospective cohort study with a follow-up of up to 25 years
Marieke A. P. Filius, DDS,a Marco S. Cune, DDS, PhD,b Petra C. Koopmans, PhD,c Arjan Vissink, MD, DDS, PhD,d
Gerry M. Raghoebar, MD, DDS, PhD,d and Anita Visser, DDS, PhDe

Oligodontia is defined as ABSTRACT

the congenital absence of 6
or more permanent teeth,
1
excluding third molars. The
prevalence of oligodontia in
the white populations of
North America, Australia,
and Europe is estimated to
be 0.14%. 2 Tooth agenesis
can be the result of environ-
mental and/or genetic factors
and can occur as an isolated
anomaly or as a feature of a
large variety of syndromes
(for example, ectodermal
dysplasia).3,4 The etiology of
tooth agenesis is complex:
more than 200 genes are
responsible for tooth devel-
5
opment. Patients with oli-
godontia commonly suffer
from functional and esthetic
problems resulting from the
large number of missing
teeth. Such patients usually
need complex oral rehabilitation.6
Several treatment options are available for patients
with congenitally missing teeth. The least invasive are the
retention of deciduous teeth, autotransplantation, and
Statement of problem. Long-term assessments of implant survival and treatment outcome in
patients with oligodontia are lacking.
Purpose. The purpose of this retrospective clinical study was to assess which factors determine a
long-term implant survival and treatment outcome of up to 25 years in a cohort of patients with
oligodontia.
Material and methods. The medical records of all patients with oligodontia treated with fixed
implant prosthodontics between January 1991 and December 2015 in the Department of Oral and
Maxillofacial Surgery at the University Medical Center Groningen, the Netherlands, were assessed.
Specifically, this involved the retrieval of records on the need for and mode of bone augmentation,
implant survival, and survival of and adverse events associated with the prosthodontics. The Kaplan-
Meier estimator was used to analyze implant and superstructure survival. Log-rank tests were used
to compare the survival of subgroups.
Results. A total of 126 patients with oligodontia were treated with dental implants. Of the 777
implants in total, 56 were lost, resulting in a 5-year cumulative survival of 95.7% (95% confidence
interval [CI], 94.2% to 97.2%) and a 10-year cumulative survival of 89.2% (95% CI, 86.2% to 92.2%).
The survival of implants placed in regions where bone augmentation surgery had been performed
was significantly lower. The 5-year cumulative superstructure survival was 90.5% (95% CI, 87.6% to
93.5%), and the 10-year cumulative superstructure survival was 80.3% (95% CI, 75.3% to 85.3%). The
performance of the screw-retained and cemented superstructures was comparable, but the survival
of single crowns was significantly higher than the survival of fixed partial dentures (P<.001).
Conclusions. Implant treatment is a predictable treatment option for patients with oligodontia with
a favorable long-term outcome. Survival of implants in augmented areas is lower. (J Prosthet Dent
2018;120:506-12)
orthodontic space closure. Retaining numerous decidu-
ous teeth not only presents esthetic concerns but often
does not have a predictable long-term outcome because
of root resorption, secondary retention, and caries.7 The

a
Doctoral student, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
b
Professor, Department of Fixed and Removable Prosthodontics and Biomaterials, Center for Dentistry and Oral Hygiene, University Medical Center Groningen and
University of Groningen, Groningen, The Netherlands.
c
Epidemiologist, Signidat, Groningen, The Netherlands.
d
Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
e
Assistant Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.

506 THE JOURNAL OF PROSTHETIC DENTISTRY

October 2018 507

Biocare or Biomet 3i implants. Treatment options and

Clinical Implications patients’ treatment willingness were always discussed
Implant treatment of patients with oligodontia has a before treatment. In the Netherlands, no relevant financial
constraint exists because dental treatment of patients with
favorable long-term outcome. Implant survival is
oligodontia has been covered by the national health in-
lower in regions in need of bone augmentation
surance scheme. Thus, all patients who needed implant
surgery.
treatment and who had no medical and/or mental con-
traindications have been eligible for this treatment. At the
UMCG, these patients were treated by a multidisciplinary
orthodontic closure of a diastema or autotransplantation
team, which included an experienced surgeon, a restorative
is only feasible when a limited number of teeth are
dentist, an orthodontist, and a dental technician.
missing, which is not the case in oligodontia. Moreover,
Bone augmentation, if and when required, was per-
orthodontic treatment in patients with oligodontia can be
formed simultaneously with the implant placement, un-
time consuming and complex.8 In addition, tooth-
less the patient needed extensive bone augmentation and
supported crowns or fixed partial dentures (FPDs) may
primary stability of the implant could not be ensured. In
not be feasible because of the unfavorable distribution of
that situation, augmentation surgery was performed
the available teeth, and the unfavorable shape (microdontia
before implant placement, and the implants were placed
or taurodontia) may also preclude conventional restora-
4 months after augmentation. A surgical guide was al-
tion.6 Oral rehabilitation using implant-retained fixed or
ways used in placing the implants. When the deciduous
removable prostheses is the treatment of choice for most
teeth were still in situ, implants were immediately placed
patients with oligodontia, and removable prostheses (with
after tooth extraction when primary stability could be
or without implant retention) are generally only indicated
ensured and favorable mucosal conditions were present.
when fixed prosthodontics are not an option, for example,
Antibiotics (amoxicillin) were started before surgery and
in patients missing all teeth (anodontia).9e11
continued for 1 week. Postoperative treatment consisted
Dental implant treatment (often in combination with
of chlorhexidine 0.2% mouth rinse for 2 weeks and an-
orthodontic therapy) is therefore the most favorable
algesics (acetaminophen) when needed. Three months
treatment option for patients with oligodontia.6,12 Favor-
after placement, the implants were uncovered and
able implant survival has been reported for fixed and
implant-based fixed superstructures were provided (sin-
removable implant prosthodontics in patients with oligo-
gle crowns or FPD). Initially, these were metal-ceramic
dontia, although these studies only report short-term
superstructures, but more recently, complete ceramic
implant survival rates.12e23 The authors are unaware of
restorations were provided for better esthetics.
published long-term (10 years) implant and prostho-
Patients were eligible for inclusion in this study if they
dontic survival rates in larger series of patients or of the
had been treated with fixed implant prosthodontics at the
effect of bone augmentation on treatment outcome.6 Bone
UMCG between January 1991 and December 2015. Pa-
augmentation is of great significance as it is often required
tients had to be diagnosed with oligodontia, which is
in patients with oligodontia because of the underdevel-
defined as the congenital absence of 6 or more permanent
opment of the alveolar bone in the area with congenitally
teeth, excluding third molars. Exclusion criteria were the
missing teeth. The frequent need for bone augmentation
presence of systemic disease and a history of head and
may influence implant survival, and bone quality may
neck radiotherapy.
differ in patients affected by oligodontia. Therefore, the
The medical records of all eligible patients were
purpose of this study was to assess which factors are
assessed. Patient characteristics, such as age, sex, general
associated with long-term implant survival and treatment
health, and the number of missing teeth, were scored,
outcome in a large cohort of patients with oligodontia. The
and potential confounding factors (bruxism, diabetes
records of these patients were analyzed for a period of up
mellitus, and smoking behavior) were identified.
to 25 years regarding factors such as implant position,
With regard to surgical treatment, the need for and
superstructure type, need for bone augmentation, and age
method of bone augmentation and implant loss were
at implant placement. It was presumed that implant sur-
noted. When bone volume was insufficient to place the
vival in augmented areas was lower.
implant in the desired position, bone augmentation was
usually performed. Bone was harvested intraorally in the
MATERIAL AND METHODS
retromolar and/or tuberosity areas or, when a large volume
Since the early 1990s, patients with oligodontia requiring of bone was required, from the posterior iliac crest. Infor-
fixed implant prosthodontics at the Department of Oral mation on the type of prosthodontic rehabilitation and
and Maxillofacial Surgery at the University Medical Center adverse technical events accompanying the prosthodontics
Groningen (UMCG), the Netherlands, have been routinely was noted. Because this study involved a retrospective
treated according to a standardized protocol with Nobel evaluation of routine dental care, the medical ethical

Filius et al THE JOURNAL OF PROSTHETIC DENTISTRY

508
committee of the UMCG granted ethical exemption
(M16.188270).
Implant survival and follow-up period were defined
as the period between implant placement and the last
follow-up or loss of the implant. Reasons for the loss of
implants were recorded and included lack of initial
osseointegration, peri-implantitis, and fracture of the
implant. Peri-implant mucositis was defined as bleeding
on probing, with or without suppuration and <2 mm of
radiographic bone loss. Peri-implantitis was defined as
bleeding on probing with or without suppuration and 2
mm of radiographic bone loss.24,25
Superstructure survival and the corresponding follow-
up period were defined as the period between definitive
superstructure placement and the end of follow-up or loss
of the superstructure. The data reported in the present
study concerned the survival and technical complications
of definitive restorations made in the UMCG. A super-
structure was considered as lost when replacement was
considered for the following reasons: fracture of porcelain,
required improvement of the fit of the superstructure or
required replacement with a different kind of superstruc-
ture (owing to loss of an adjacent implant or teeth), or
replacement for esthetic reasons. Reversible adverse events
of the superstructure, that is, events that did not result in
replacement of the superstructure, were also recorded us-
ing the following parameters: chipping/porcelain fracture,
loose screws, cement failure, loss or discoloration of screw
access restoration, and broken screws.
Implant and superstructure survival were analyzed at
the implant level using Kaplan-Meier analyses. The 5- and
10-year cumulative survival scores were calculated with
95% confidence intervals (95% CI) with statistical software
(IBM SPSS Statistics, v22.0; IBM Corp). Subgroup analyses
were performed for sex, number of missing teeth (<10
versus 10), presence of ectodermal dysplasia, implant
brand, implant location (anterior versus distal to canine
region), source of bone needed for bone augmentation
(intraoral versus extraoral), and type of implant placement
(immediate versus delayed). The survival of subgroups was
compared using the log-rank test. Censored and non-
censored data were plotted against time to evaluate the
assumption that censored and noncensored data arose
from the same distribution. The distributions across the
subgroups were also evaluated for similarity. To estimate
hazard ratios, a marginal Cox model was applied using
statistical software (SAS 9.4; SAS Institute Inc) to account
for correlated data in patients with multiple implants. The
proportionality assumption was examined by graphical
checks or by applying supremum tests using the Assess
statement in PROC PHREG in SAS.26 An implant or su-
perstructure was considered lost once it was removed
permanently from the mouth. Replaced implant(s) or su-
perstructure(s) were excluded for further (survival) ana-
lyses. Results are expressed as hazard ratios with 95% CIs.
THE JOURNAL OF PROSTHETIC DENTISTRY
Volume 120 Issue 4
The variables examined in the univariate and multivariate
analyses included sex (male; female), number of missing
teeth, age at implant placement, general health (including
ectodermal dysplasia), implant location, augmentation of
implant site, dental implant brand, immediate or delayed
implant placement (immediate: immediately after removal
of deciduous teeth), and type of superstructure (crown or
FPD; a=.05).
RESULTS
A total of 126 patients with oligodontia were included
(Table 1). No patient was excluded because of systemic
disease or a history of radiotherapy in the head/neck region.
The influence of potential confounding factors (bruxism,
diabetes mellitus, and smoking behavior) was limited.
Therefore, no confounding analyses were performed. The
plot of censored and noncensored data against time
showed no particular patterns, so the assumption that
censored and noncensored data arose from the same dis-
tribution was not violated. This also held for the various
subgroups.
The median follow-up of the 777 implants was 6 (2 to
10) years (range: 0 to 25 years). Of a total 777 placed
implants, 56 were lost. This resulted in a 5-year cumu-
lative survival of 95.7% (95% CI, 94.2% to 97.2%) and a
10-year cumulative survival of 89.2% (95% CI, 86.2% to
92.2%; Table 2; Fig. 1). Subgroup analyses showed no
statistically significant difference in survival between
sexes (P=.554, log rank), number of missing teeth (<10
versus 10) (P=.477, log rank), presence of ectodermal
dysplasia (P=.362, log rank), implant brand (P=.725, log
rank), implant location (anterior versus distal to canine
region; P=.101, log rank), source of bone needed for bone
augmentation (intraoral versus extraoral bone; P=.925,
log rank), and type of implant placement (immediate
versus delayed; P=.964, log rank).
The need for bone augmentation was significantly
associated with implant survival (Fig. 2; hazard ratio:
5.30; 95% CI, 1.99 to 14.16; P<.001), whereas a higher
age at implant placement was associated with more
implant failure (Fig. 3; mean hazard ratio: 1.80; 95% CI,
1.25 to 2.59 per 10 years; P=.002). Location (maxilla
versus mandible) did not affect the implant survival as
the average hazard ratio from the Cox regression ana-
lyses was not significant (P=.126). Because the propor-
tionality assumption was not met, a stratified multivariate
analysis on location was performed. Augmentation and
age at implant placement influenced implant survival
independently of each other with hazard ratios of 4.75
(95% CI, 1.74 to 12.97) for augmentation (P=.002) and
1.70 (95% CI, 1.29 to 2.23) per each additional 10 years of
age at which the implant was placed (P<.001).
Of the 721 implants that are still in situ, peri-implant
adverse events were reported for 160. The most common
Filius et al
October 2018 509

Table 1. Patient characteristics and dental implant information Table 1. (Continued) Patient characteristics and dental implant
Patients information
Total 126 Right mandibular second premolar 80 (10.3)
Median age at implant placement in years (IQR) 21 (19-27) Right mandibular first molar 13 (1.7)
Current median age in years (IQR) 31 (25-37) Right mandibular second molar 2 (0.3)
Sex (male/female) (%) 44 (35)/82 (65) Number of implants requiring bone augmentation (%) 484 (62)
Number of patients diagnosed 10 (7.9) Only intraoral bone 242 (50)
with ectodermal dysplasia (%)
(Intraoral and) extraoral bone 242 (50)
Number of patients with bruxism (%) 1 (0.8)
Number of implants placed 64 (8)
Number of smokers (%) 15 (11.9) directly after extraction of the deciduous teeth (%)
Median number of missing teeth (IQR) 10 (7-12)
IQR, interquartile range.
Prevalence (mean %) of absent
tooth types in sequence (n=126 patients)
Third molar 83 Table 2. Information about lost and surviving implants
Mandibular second premolar 73 Placed implants
Maxillary second premolar 62 Total 777
Maxillary lateral incisor 56 Lost implants
Maxillary first premolar 50 Total 56
Mandibular second molar; 47 In the maxilla (%) 40 (71)
mandibular central incisor
In the mandible (%) 16 (29)
Maxillary second molar 42
Reasons for failure (n)
Maxillary canine 39
Lack of osseointegration/mobility 29
Mandibular first premolar 31
Peri-implantitis 23
Mandibular lateral incisor 27
Placed too close to mandibular nerve 1
Maxillary first molar 22
Unknown 3
Mandibular canine 19
Number of lost implants <1 y 27 (48%) in 21 patients
Mandibular first molar 13 after placement
Maxillary central incisor 2 Number of reimplantation after loss (n)
Implants Reimplanted 22 (of which 21 are still in situ)
Total 777 Planned reimplantations 6
Nobel Biocare 515 No need for reimplantation 28
Biomet 3i 262
Implants per tooth region (%)
Right maxillary central incisor 3 (0.4)
adverse events were peri-implantitis, peri-implant
Right maxillary lateral incisor 40 (5.1)
Right maxillary canine 48 (6.2)
mucositis, and/or gingival recession.
Right maxillary first premolar 45 (5.8)
Definitive superstructure evaluation was not possible
Right maxillary second premolar 62 (8.0) for 96 of the 777 implants because the definitive restora-
Right maxillary first molar 15 (1.9) tions were made by dentists outside the UMCG (n=11),
Right maxillary second molar 0 (0) and definitive fixed prosthodontics was not provided
Left maxillary central incisor 3 (0.4) because of early loss of implant(s) (n=25), recent placement
Left maxillary lateral incisor 44 (5.7) of implants (n=59), or unfavorable implant placement
Left maxillary canine 51 (6.6) (n=1). All the patients had multiple implants, and there-
Left maxillary first premolar 43 (5.5) fore, a patient could have 1 or more superstructure-related
Left maxillary second premolar 62 (8.0) adverse events (2 patients had 2 different events). Super-
Left maxillary first molar 18 (2.3) structures made to replace a failed implant were not
Left maxillary second molar 0 (0)
analyzed. Consequently, a total of 578 definitive super-
Left mandibular central incisor 13 (1.7)
structures supported by 681 implants (n=113 patients;
Left mandibular lateral incisor 8 (1.0)
Table 3) were available for evaluation. Median follow-up of
Left mandibular canine 22 (2.8)
the 578 superstructures was 3 (1 to 8) years (range, 0 to 25
Left mandibular first premolar 35 (4.5)
Left mandibular second premolar 75 (9.7)
years). The 5-year cumulative superstructure survival was
Left mandibular first molar 11 (1.4)
90.5% (95% CI, 87.6% to 93.5%), and the 10-year cumu-
Left mandibular second molar 2 (0.3) lative superstructure survival was 80.3% (95% CI, 75.3%-
Right mandibular central incisor 18 (2.3) 85.3%). Screw-retained and cemented superstructures
Right mandibular lateral incisor 10 (1.3) performed similarly, but survival was significantly higher
Right mandibular canine 21 (2.7) for single crowns than that for FPDs (Fig. 4). The reasons
Right mandibular first premolar 33 (4.2) for replacing definitive superstructures and reversible
(continued on next column) adverse events are given in Table 3.

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1.0 1.0
Cumulative Survival

Cumulative Survival
0.8 0.8

≤24 y
0.6 0.6
25-34 y
≥35 y

0.0 0.0
0 5 10 15 20 25 0 5 10 15 20 25
Time Elapsed (y) Time Elapsed (y)
Figure 1. Cumulative implant survival (n=777) in 126 patients Figure 3. Cumulative implant survival in relation to age at implant
(Kaplan-Meier). Cumulative survival after 5 years was 95.7% (95% CI, placement of different age groups (24 years [n=571]; 25 to 34 years
94.2% to 97.2%) and after 10 years was 89.2% (95% CI, 86.2% to 92.2%). [n=120]; 35 years [n=86]; Kaplan-Meier). Higher age at implant
CI, confidence interval. placement was associated with more implant failure (P<.001, log rank;
mean hazard ratio, 1.80; 95% CI, 1.25 to 2.59, per 10 years; P=.002). CI,
confidence interval.
1.0
Cumulative Survival

The 10-year implant survival in oligodontia (89.2%)

0.8
No bone augmentation
0.6 Bone augmentation
0.0
0 5 10 15 20 25
Time Elapsed (y)
Figure 2. Cumulative implant survival after augmentation
(Kaplan-Meier). Log-rank test was significant (P<.001), and
proportionality assumption was met. Implant survival was significantly
lower in augmented regions (hazard ratio, 5.30; 95% CI, 1.99 to 14.16;
P<.001). CI, confidence interval.
Of all the implants attached to a definitive super-
structure (n=681, 113 patients), 31 implants were lost.
Of these lost implants, 6 supported a cantilever FPD on
2 or more implants, 12 were provided with a single
crown, 6 incorporated an FPD on 2 implants, and 7
incorporated an FPD on more than 2 implants. Implant
survival was significantly higher for implants provided
with single crowns than that for implants with FPDs
(Fig. 5; P=.003, log rank; hazard ratio, 2.88; 95% CI, 1.06
to 7.83; P=.038).
DISCUSSION
This study assessed factors that determine long-term
implant survival and treatment outcome in a cohort of
patients with oligodontia. The results of this study show
that implant-supported prostheses are a favorable treat-
ment option for patients with oligodontia. This is reflective
of the reasonable 5- and 10-year survival of the implant
and superstructure and the fact that the outcome of the
implant-supported prosthodontics was favorable. As pre-
sumed, implants placed in native bone were more likely to
survive than implants placed in augmented bone.
was lower than that reported for implants with fixed
prostheses placed in noncompromised patients.27,28
However, this can be considered as reasonable for
compromised bone and thus supports the use of implant-
supported prosthodontics in patients with oligodontia. The
main reasons for implant failure were comparable with
those reported previously for noncompromised pa-
tients.27,28 Lower implant survival in oligodontia can be
explained by the fact that bone augmentation is often
needed because bone quantity is lacking.
Agenesis of permanent teeth is usually accompanied
by vertical and horizontal alveolar bone atrophy and the
absence of supporting bone.29 Therefore, bone
augmentation is often needed to allow for reliable
implant placement in patients with oligodontia.29
Augmented bone is, however, considered more suscep-
tible to bone resorption than native bone, particularly
when a vertical defect has to be reconstructed.30 When
resorption of the augmented bone progresses, the im-
plants placed in such regions are prone to develop peri-
implantitis and subsequently leads to implant loss.30,31
In comparison with vertical defects, the outcome
regarding bone loss after horizontal bone defect recon-
struction is more favorable and more predictable.32,33
Unfortunately, vertical defects are more common in pa-
tients with oligodontia relative to noncompromised pa-
tients because in oligodontia, a dental precursor to
prevent vertical alveolar atrophy is lacking.29 This may
underlie the less favorable implant survival rate in pa-
tients with oligodontia, relative to noncompromised pa-
tients. In older patients, bone resorption had progressed.
Therefore, more implants were needed to be placed in
augmented bone, which may explain the higher implant
failure rate for implants placed in older patients. There-
fore, an implant should be placed soon after the loss of a
deciduous tooth without a successor so that the implant

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October 2018 511

Table 3. Superstructure information 1.0

Definitive superstructures Placed (S%/C%) Lost (S%/C%)
Total 578 (68/32) 70 (50/50)
Single crowns 482 (68/32) 45 (38/62) 0.8
Single implant cantilever FPD 31 (58/42) 2 (50/50)

Cumulative Survival
Implant-supported cantilever 32 (81/19) 13 (85/15)
FPD on 2 or more implants 0.6
Implant-supported FPD on 2 implants 20 (65/35) 6 (83/17)
Implant-supported FPD 11 (64/36) 2 (50/50)
on more than 2 implants 0.4
Tooth implantesupported FPD 2 (0/100) 2 (0/100)
Reason for replacing definitive superstructures (total=70)
0.2
Fracture of superstructure porcelain 25 Crown
Loss of (one of) 21 FPD
superstructure implant(s)
Replacement because of change 3 0.0
0 5 10 15 20 25
in superstructure type due to
loss of adjacent implant Time Elapsed (y)
Replacement because of change in 9 Figure 4. Cumulative superstructure survival of single crowns versus
superstructure type due to loss
of adjacent tooth FPDs (Kaplan-Meier). Survival was significantly higher for single
Replacement for esthetic reasons 8 crowns than that for FPDs (P<.001, log rank; hazard ratio, 2.28; 95%
Replacement to 2 CI, 1.15 to 4.51; P=.018). CI, confidence interval; FPDs, fixed partial
improve fit of superstructure dentures.
Loss due to debonding 2
Superstructure-related reversible adverse events
Total of all definitive 124 (22%) 1.0
Cumulative Survival

superstructures with
one or more noticeable
superstructure-related
reversible adverse events 0.8
Percentage of most commonly noticed Total is 100%
superstructure-related reversible
Crown
adverse events in sequence 0.6
Chipping/porcelain fracture 37 FPD
Loose superstructure 31 0.0
due to screw loosening 0 5 10 15 20 25
Loose cemented 17 Time Elapsed (y)
superstructure due to debonding
Figure 5. Cumulative implant survival in relation to superstructure type
Loss or discoloration of 14
screw access restoration (Kaplan-Meier). Implant survival was significantly higher for implants
Fractured screw 1 with single crowns than that for FPDs (P=.003, log rank; hazard ratio,
2.88; 95% CI, 1.06 to 7.83; P=.038). CI, confidence interval; FPDs, fixed
C, cemented superstructure; FPDs, fixed partial dentures; S, screw-retained
superstructure. partial dentures.

can be placed in native bone.29 Unfortunately, no re-
cords were available as to when a patient lost a de-
ciduous tooth. For this study, therefore, analyzing the
factor "time since the loss of deciduous teeth" was
impossible. Muddugangadhar et al34 reported a meta-
analysis of the cumulative survival of implant-
supported fixed prosthodontics in noncompromised
patients. They concluded that survival rate was higher
for single crowns than FPDs, consistent with the re-
sults of the present study. This may be because single
crowns are less loaded and easier to clean, and un-
favorable forces are avoided. The 5-year survival rates
of fixed prosthodontics as reported by Muddu-
gangadhar et al34 were slightly higher than the
5-years’ results of the present study (Fig. 4). In
addition, the long-term risk for superstructure
replacement in oligodontia patients due to loss of an
adjacent tooth or implant is probably higher than that
in noncompromised patients.
For the 5- and 10-year implant survival probabilities,
Kaplan-Meier estimates were used for the independent
model in the present study. However, as the implants are
nested within patients, the standard errors and the
confidence interval width would be underestimated.35
For events with high survival rates, the assumptions
regarding dependency of events would have a small ef-
fect on the point estimate and variance.35 In this study,
the 5-year and 10-year survival probabilities were all
>89%, except for the 10-year cumulative superstructure
survival, which had a survival probability of 80%.
Therefore, the confidence interval of the 10-year super-
structure survival should be interpreted with caution.
A major limitation of this study is its retrospective
design. During the 25-year follow-up, a variety of

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512
innovations took place. For example, metal-ceramic su-
perstructures have been superseded by ceramic super-
structures. Unfortunately, determining the exact
influence of these innovations on the results was not
possible. As none of the patients with oligodontia who
were treated with implant-supported fixed prosthodon-
tics were excluded from this study, attrition bias does not
apply. Many variables were analyzed in this study, and
therefore, potential capitalization on chance has to be
considered.
CONCLUSIONS
Based on the findings of this retrospective clinical study,
the following conclusions were drawn:
1. Implant treatment is a predictable treatment option
for oligodontia, from the perspective of both the
survival of the implants themselves and the fixed
prosthodontics.
2. Factors that affect implant survival unfavorably are
placement of implants in augmented regions or at
an older age.
3. With regard to prosthodontics, single crowns have a
better prognosis than FPDs.
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Corresponding author:
Dr Anita Visser
Department of Oral and Maxillofacial Surgery
University Medical Center Groningen
PO Box 30.001
NL-9700 RB Groningen
THE NETHERLANDS
Email: a.visser@umcg.nl
Acknowledgments
The authors thank native English speaker C. Frink for critically reading our
manuscript and making suggestions to improve the English.
Copyright © 2018 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2017.12.009
Filius et al